Basic Information
Provider Information | |||||||||
NPI: | 1225364631 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | DANIEL ENE-STROESCU MD PS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 97115 | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | WA | ||||||||
PostalCode: | 984970115 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2535887911 | ||||||||
FaxNumber: | 2539846774 | ||||||||
Practice Location | |||||||||
Address1: | 11102 SUNRISE BLVD E | ||||||||
Address2: | SUITE-102 | ||||||||
City: | PUYALLUP | ||||||||
State: | WA | ||||||||
PostalCode: | 983748846 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2534452385 | ||||||||
FaxNumber: | 2534450384 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/20/2009 | ||||||||
LastUpdateDate: | 10/20/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ENE-STROESCU | ||||||||
AuthorizedOfficialFirstName: | DANIEL | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
AuthorizedOfficialTelephone: | 2534452385 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00042031 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | MD00042031 | 01 | WA | PHYSICIAN AND SURGEON LICENSE | OTHER | 1123470 | 05 | WA |   | MEDICAID |